Letters to health-care Santa: Competition for care, not just insurance

Over the course of this week, I'll be asking some health-care experts what they'd like Santa to add to the bill during conference committee, and publishing their responses on the blog. Next up is George Halvorson, chairman and chief executive of Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals. Kaiser Permanente is the nation’s largest nonprofit health plan and hospital system, serving more than 8.6 million members and generating $40 billion in annual revenue.

If I could add one thing to the bill, I would make the exchanges more robust and require them to provide consumer focused data about care team choices and performance. It can be done if it is designed into the exchange requirements. When your chance of dying within five years from late stage prostate cancer ranges from thirty percent to almost seventy percent depending on the care team you select, and when your chance of dying from major heart surgery varies by a multiple of twelve -- also depending on your care team -- we clearly need consumers to be able to make much better informed choices about care and the teams who deliver care.

The exchanges as designed in the current bill deal with health plan choices only. That is a wasted opportunity. The future health plan marketplace for America should be about dueling care teams, not dueling actuaries. Let's not miss this chance to transform care by building the exchange model with components that help consumers make smart choices. Insurance competition is good. Care team competition is better. Exchanges should have low barriers to entry for accountable health systems and high standards for important data about care outcomes and successes. It's not too late to go down that path. The entire bill can point us in a direction that facilitates care delivery reform as well as insurance reform. We need both.

"Letters to Santa" is right. Nothing is going to change in committee, 'cause if it did Nelson and/or Lieberman will take their ball and go home. And after this bill no one's going to touch health care reform in the United States again for decades. So what's the point of this series? Just to remind us of all the wonderful things we're not getting?

While reading this post a thought occurred to me that may not be appropriate for this venue. (oh well the moderator can always delete it)

I did a little online research in regards to medical tourism a while back in response to another blogger claiming that the U.S. has the best health care delivery system in the world. (not by my research it doesn't) and that thousands come from all over the world to have surgery in the U.S. (true statement).

I found the converse to that statement to be true as well. Thousands travel from the U.S. to other countries for elective surgery.

In the course of that investigation I found that India is a major destination point for U.S. medical tourists. Their complication rates are much lower than in U.S. hospitals. Their outcome satisfaction rates are higher. Their infection rates are less than 1/2 of what they are here. Including the cost of air fair, luxury hotel, and medical expenses some surgeries can be had for nearly 1/10th of the U.S. costs.

If surgery over seas is found to be of better quality than local product at a much reduced price, will health care reform cover this cost? I sincerely doubt it. But it is an interesting consideration, is it not?

Annual premium increases for health insurance cost are out of control! The insurance industry business model of the cancellation of policy-holders when they get sick and actually need care for long periods is reprehensible. Big health insurance companies have entrenched themselves and their lobbyist firms for decades in this battle to federally mandate consumer protections at the heart of this reform bill. The public option is not on the table due to the corporate control of the senate. A critically important yet MISSING component of this reform is a trigger. Senator Stowe of Maine, senator Lieberman of Connecticut and senator Nelson of Nebraska (2 of the three last votes to the supermajority and the only republican to ever venture a hint of approval) all supported a trigger to police the health insurance companies and trigger a single payer federal plan if they do not follow the letter of the law. These companies have an established history of violating state regulations and abusing the public trust. If there is no trigger to keep insurance companies honest then this bill will be a complete and utter failure. As it stands backed with a trigger provision this will be a quantum leap for our country both economically and morally! Without a highly defined ready to implement trigger this bill will never be enforceable.